Study Guide #16 Oxygenation

Terms

-designed to store the oxygen at a precise and safe temperature and deliver it as a gas through wall outlets in a client's room.-stored at or below -297 degrees F and requires the use of a small ambulatory tank that is filled from a resevoir in the home

Portable Tank

-easily moved-weigh more than 10 pounds-not designed to be carrried-deliver oxygen for about 5 hours at 2L/min.

Tidal Volume

-amount of air inpires and expired with each breath-usually set at 8-15 mL/Kg of ideal body weight.

Positive-pressure Ventilation

-assists in reinflation-delivers positive pressure to inflate the lungs

-assists the client in deep breathing-most often used following abdominal or thoracis surgery to help reduce the incidnece of post-operative pulmony atelectasis

Oxygen Tent

-a tent has been placed over a bed for the continuous administration of oxygen and mist.-commonly used in the pediatric setting-able to provide high concentration of humidified oxygen

Venturi Mask

-can be used to deliver oxygen concentration of 24% to 55% with oxygen flow rates fo 2 to 14 L/min-cone shaped device with entrainment parts of various sizes at the bas of the mask to permit regulation of FiO2 from 24% to 60%. -The mask is useful because it delivers a more precise concentration of Oxygen to the client

Dyspnea

-clinical sign of hypoxia and manifest as breathlessness-subjective sensation of difficult or uncomfortable breathing

Orthopnea

-an abnormal condition in which the person must use multiple pillow when lying down or must sit with the arms elevated and leaning forward to breathe.

Nasal Cannula

-a simple, comfortable device used for oxygen delivery-tubing used to deliver oxygen at levels from 1 to 6L/m-it is used in situations such as cardiac disease, in which a low-flow, small % oxgyen therapy is desireable.

-blue discoloration of the skin and mucous membranes caused by the presence of desaturated hemoglobin in cappilaries-a late sign of hypoxia

A pulse deficit provides information about the heart's ability to adequately perfuse the body. A pulse deficit is:1. the difference between the radial and apical pulse rates.2. the digital pressure felt when taking radial and ulnar pulses.

1-an insufficient contractuon of the heart that fails to transmit a pulse wave to the periperal pulse site creates a pulse deficit. to assess a pulse deficit, the nurse and a collegue assesses radial and apical rates ismultaneously and then compare rates. the difference between the Ap and radial pulse rates is the pulse deficit. pulse deficits are frequently associated w/abnormal rhythms.

The nursing assistant reports to the nurse that a client is "feeling funny". the nurse's first action would be:1. obtain the VS herself.2. instruct the nurse assistant to retake VS.3. insturct the nursing assistant to continue

If a BP cuff is too narrow, or wrapped too loosely, the BP reading will be:1. falsely low2. falsely high3. difficult to hear b/c sounds will be muffled.4. dependent on the examiner's hearing acuity

2-BP mesurements will not be accurate unless the correct size BP cuff is applied appropriately. If a cuff is too small/tends to come loose, the result is a false high reading.

Client's w/apnea expierience:1. difficult respirations requiring more effort2. slowness of breathing followed by rapid breathing3. cessation of breathing that may be temporary4. lack of O2 to body tissue and organs

3-respirations cease for several seconds. persistant cessation results in resp. arrest. andy irregular resp. pattern/periods of apnea are symptoms of underlying disease in the adult and must be reported to the physician or nurse in charge.

The nurse obtaind a supine BP reading of 130/64. One hour later, the BP (supine) 134/62, and sitting BP 95/62. The nurse's immediate action is to:1. assist the client to return to a supine position.2. obtain a BP in the other arm.3. rep

1-if orthostatic hypotension is assessed the client is assisted to a lying positon and the physician or nurse in charge is notified. while obtaining orthostatice measurements, the nurse observes for other symptoms of hypotension; such as fainting, weakness, or light-headedness. b/c the skill of orthostatice measurements requires critical thinking and ongoing nursing judgement, this procedure is not delegated to unliscensed assistive personnel.

A nurse is taking VS & notes the client has a strong radial pulse that dimenishes in intesity & has an interruption in rhythm about q4-6 beats. the nurse's immediate action is to:1. report the findings to a physician2. measure a 60 se

4-when assessing the pulse, the nurse must consider the variety of factors influeincing the pulse rate. A combination of the factors may cause significant changes. If the nurse detects an abnormal rate while palpatin a peripheral pulse, the next step is to assess the Ap. pulse.

1-conduction is the transfer of heat form one object to another w/direct contact. heat conducts through contact w/solids, liquids & gases. when the warm skin touches a cooler object, heat is lost. conducitno normally accounts for a small amount of heat loss. the nurse increases conductive heat loss when applying an ice pack or bathing a clinet w/cool water.

1-the basic techniques of inpeciton, palpation, and auscultation are used to determine VS. these skills are simple, but should not be taken for granted. careful measurement techniques ensure accurate findings. VS & other physiological measurements are the basis for clinical problem solving. VS assemssment is an essential ingredient when nurses & physician's collaborate to determine the client's health status.

When the nurse takes the client's radial pulse, he notes dysrhythmia. his most appropriate action is:1. inform the physician immediately2. wait 5 minutes & retake the radial pulse.3. take the pulse Ap. for one full minute.4. c

3-take the pulse Ap. for one full minute

The nurse is assessing a client who she suspects has the nursing diagnosis hyperthemia to vigorouse exercise in hot weather. in reviewing the data, the nurse knows that the most important sign of heatstroke is:1. confusion2. hot, dry skin

2-hot, dry skin

The nurse bathes a client who has a fever w/cool water. the nurse does this to increase heat loss by means of:1. radiation2. convection3. condnesation4. conduction

1-anemia, a lower than normal hemoglobin level is a result of decreased hemoglobin produciton, increased RBC destruction, c/o fatigue, decreased activity tolerance and increased breathlessness, as well as pallor (esp. seen in conjuctiva of the eye) and increased heart rate.

The most common toxic inhalant that decreases the oxygen-carrying capacity of blood is:1. carbon dioxide2. carbon monoxide3. nitrogen4. mustard gas

2-carbon monoxide is the most common toxic inhalent that decreases the oxygen-carrying capacity of blood. the affinity for hemiglobin to bind w/carbon monoxide is greater than 200 times its affinity to bind w/O2, creating a funcitonal anemia b/c of the bonds strenght, carbon monoxide is not easily disassociated from hemoglibin, making the hemoglobin unavailabel for O2 transportation.

1-conditions such as shock and severe dehydration resulting from extracellular fluid loss & reduced circulating blood volume cause hypovolemia. w/a significant loss the body tries to adapt by increasing the heart rate and peripheral vasoconstriction to the increase the volume of blood returend to the heart and in turn increasing cardiac output.

2-fever increases the tissues' need for O2, & as a result, carbon dixide production also increases. if the febrile state persists, the metabolic rate remains high and the body begins to breakdown protein stores, resulting in muscle wasting and decreased muscle mass. Resp. muscle such as the diaphram and intercostal muscles are also wasted.

1- R-sided heart failure results from impaired funtioning of the R ventricle, characterized by veous congestion in the systemic circulation. R-sided heart failure more commonly results form pulmonary disease or as a reult of long term L-sided failure.

What is the primary factor in R-sided Failure?

-elevated pulmonary vasular resistance (PVR). as the PVR increases, the R ventricle must generate more work and the O2 demand in the heart increases. as the failure continues, the amount of blood ejected from the R ventricle decreases & blood beginst to "back up" in systemic circulation. Clinically, the client has weight gain, distended neck veins, hepatomegally, and slenomegally, and dependant peripheral edema

Cyanosis, the blue discoloration of the skin and mucous membranes caused by the presence of desaturated hemoglobin in capillaries is a/an:1. early s/o hypoxia2. late s/o hypoxia3. reliable measure of O2 status.4. non-life threaten

2-late s/o hypoxia. the presence/absence of cyanosis is not a reliable measure of oxygenation status.

A person who starts smoking in adolscence & continues to smoke in middle age:1. has in incrased risk for cardiopulmonary disease and lung cancer.2. has an increased risk for obesity & diabetes3. has an increased risk for stress-

-a person who starts smoking in adolescence & continues to smoke in middle age has an incrased risk for cardiopulmonary disease and lung cancer

The most effective positon for a client w/cardiopulmonary disease is the:1. supine position2. prone position3. high fowlers4. 45 degree semi-fowler's

4-the most effective positon for a client w/cardiopulmonar diseases is the 45 degree semi-fowler's position, using gravity to assist in lung expansion & reduce pressure form the abdomen on the diaphram.

Afterload refers to:1. the amount of blood ejected from the L ventricle each minute2. the amount of blood ejected from the L ventricle w/each contraction3. the resistance to L ventricle ejection4. the amount of blood in the L vent

3-the resistance to L ventricle ejection

The movement of gases into and out of the lungs depends on:1. a 50% O2 content int he atmospheric air2. Pressure gradient between the atmosphere & the alveoli3. use of accessory muscles of respiration during expiration4. amoun

2-pressure gradient between the atmosphere & the alveoli

The client's ECG shows an abnormal rhythm that slow during inspiration & increases w/expiration. the rate is 70-80 beats/minute. the P-wave, PR interval, and QRS comples are normal. this is referred to as:1. sinus tachycardia2. sinus dysr

2-sinus dysrythmia

Mr. Isaac comes to the ER c/o difficulty breathing. An objective finding associated w/his dyspnea might include:1. statements about a sense of impending doom.2. c/o SOB3. feelings of heaviness in the chest4. use of accessary muscl

4-use of accessary muscles of respiration

The use of chest physiotherapy to mobilze pulmonary secretions involves the use of:1. hydration2. percusssion3. nebulization4. humidification

2-percussion

Partial assessment of a dyspneic client would not include which of the following?1. respiratory risk2. sputum3. chest x-ray4. breathing pattern

BiPap differs from CPAP in that:1. positive pressrue is only given during inhalation2. positive pressure is only given during exhalation3. it uses negative rpessure during inhalation & exhalation4. it uses positive pressure du

4-it uses positive pressrue during inhalaiton and exhalation

Your client is on mechanical ventilation. suddenly he develops severe resp. distress, his VS changes, his O2 saturation suddenly decreases and his trachial tube is no longer midline. you suspect a tension pneumothorax. your immediate actions are to:

1-begin manual vintillation and obtain VS and pulse ox. ASAP

Your client has a large amount of pulmonary secretions. over the last hour, you note that the secretions are thicker & the volume has incresed. during the last 30 minutes, the pressure alarm on the mechanical ventillator has triggered repeatedly. wha

-rate of breathing is regular, but abnormally rapid (>12 breaths/minute)

Hypoventilation

-respiratory rate is abnormally low, and depth of ventillation may be depressed. -Hypercarbia may occur -alveolar ventillation is inadequate to meet the body's O2 demand or to eliminate sufficient carbon dioxide

Hyperventilation

-rate and depthe of respiration increase -hypocarbia may occur -state of ventillation in excess of that required to eliminate the normal venous carbon diaxide produced by cellular metablolism -can be induced by: anxiety, infections, drugs or an acid-based imbalance fever

What are the respiratory rates for a newborn?

30-60 breaths per minute

what are the respiratory rates for an infant (6 months)

30-60 breaths per minute

what are the respiratoy rates for a toddler (2 years)?

25-32 breaths per minute

what are the respiratory rates for a child?

20-30 breaths per minute

what are the respiratory rates for an adlolescent?

16-19 breaths per minutes

what are the respiratory rates for an adult?

12-20 breaths per minute

the % of hemoglobin that is bound with oxygen in the arteries is the % of saturation of hemoglobin (SaO2)

It is usually between 95% and 100%

Bradypnea

Rate of breathing is regular but abnormally slow (>12/min)

Systolic BP

the peak of maximum pressure when ejection occurs

Diastolic BP

the minimal pressure exerted against the arterial walls at all times

Pulse Pressure

the difference between systolic and diastolic pressure (i.e. 120/80=40)

Pulse Oximeter

permits the indirect measurement of oxygen saturation

Biot's Respiration

Resp. are abnormally shallow for 2-3 breaths, followed by irregular period of apnea.

The process by which energy is propogated through space/matter. the emission of rays in all directtions from a common center. ionizing rays used for diagnotsic or therapeutic purposes.

Conduction

-the process whereby a state of excitiation affects adjacant portions of a tissue/cell so that the disturbances is transmitted to remote points -occurs in muscle fibers inthe nervous system. -the transfer of electrons, ions, heat or sound waves through a conductor/conducting medium

Convection

-the movement of sollutes that occurs during ultrafilltration of a fluid -loss of body heat by means of transfer to the surrounding cooler air

Evaporation

-change from liquid to vapor -loss in volume d/t conversion of a liquid into a vapor

Flowmeter

-a device for measuring the movement of a gas/liquid -used esp. in monitoring the use of anesthetic gases.

-abnormal condition charaterized by impaired functioning of the left ventricle d/t elevated pressure and pulmonary congestion

Right-sided Heart Failure

-results from impaired functioning of the right ventricl characterized by venous congestion in the systemic circulation. -more commonly results from pulmonary diseases or as a result of long-term left sided failure

Electrocardiogram (ECG/EKG)

-reflects the electrical activity of the conduction system. -monitors the regulartity and path of the electrical impulse through the conduction system -the normal sequence is normal sinus rhythm (NSR)

-the interchange of gases between an organish and the medium in which it lives. -the act of breathing during which the lungs are provided with air through inhaling and the CO2 is removed through exhaling. Normal respiratory exchange of O2 and CO2 in the lungs is impossible unless the pulmonary tissue is adequately perfused with blood.

Oxygen Concentrator

-a device used for home oxygen therapy that removes most of the nitrogen fromt he room air and delivers the oxgyen at a low flow rate

Ventilation

-the movement of gases in and out of the lungs

Non-rebreather Mask

-an oxygenadministration device with one-way valves for inpiration and expiration and a reservoir bag; used to attain high concentrations of oxygen

Nasal Catheter

-a tube inserted into the nose made of plastic, used to inject fluids (oxygen) into the nose

A 7 year old child who is receiving chemotherapy for acute lymphocytic leukemia is about to be discharged from the hospital. Which of the statements made by the child's mother indicates the need for follow-up by the nurse? 1. "I should call the phys

2 "I will have to learn how to take rectal temperatures with a glass thermometer."

Betty has purchased a new electronic BP monitoring device. Which of the following nursing actions will verify the accuracy of the BP monitor? 1. Nothing needs to be done. Electronic BP monitors are extremely accurate. 2. Have Betty take her daughter's BP

3 Take Betty's blood pressure with a manual aneroid sphygmomanometer right after Betty takes her blood pressure with her mother.

A group of clients are enrolled in an exercise class. Which pulse site would be best for monitoring exercise tolerance? 1. femoral 2. brachial 3. anecubital 4. radial

4 Radial

Which of the following should the nurse teach a client who is being discharged from the hospital with home oxygen therapy? 1. The client should not allow people in the home to smoke. 2. The client should be able to attend his son's Boy Scout campfire. 3.

1 The client should not allow people in the home to smoke.

A client using a concentrator oxygen delivery system at home. Which of the following statements when made by the client indicates understanding of client education? 1. If my concentrator does not reach the outlet in my house, I will use an extension cord

3 I need to make sure my breaker box will meet the electrical requirements of the concentrator.